University of Southampton

Abstract

Teaching and Learning Ethics in General Practice training

A number of authors have expressed concerns about the lack of “a body of knowledge and a community of scholars”¹ in the moral philosophy of primary care. One aspect is that few GP trainers have training in the rational analysis of ethical problems, and so are not well equipped to teach their trainees how to tease out the issues they face. UK trained doctors receive some formal education in ethics as part of their undergraduate training, although the nature of this varies between students and medical schools; many international graduates do not. Thus some trainees will have considerable ethical expertise, others may have little more than an impression of the Duties of a Doctor² and Beauchamp and Childress’s Four Principles. ³

Initially the MRCGP curriculum⁴ included a statement on ethics and value based care, but this has now been removed since it is felt that ethical issues should be covered throughout the curriculum. An analysis of the curriculum suggests moral relativism, emotivism and/ or positivism may underlie its attitude to ethical analysis.

In this presentation questions about the role of philosophical medical ethics in GP training and its implications for teaching the teachers, for curriculum and timetable design and for assessment will be explored:

• Do GPs need the technical skills of moral philosophy to practice well, or can they be “unconsciously competent” in this area? How are competence, reflection and reflexivity related?
• Should ethics be identified as a specific area of the curriculum or, since all aspects of medicine have a moral component, should it be a thread across the whole curriculum?
• What should be the relationship between ethics and law in the GP curriculum?
• Is facing a moral problem which you have no satisfactory way of addressing a cause of psychological distress in clinicians, and does this contribute to low morale and burn out?
• What is the relationship between learning and teaching the intellectual skills of moral analysis and the personal qualities, virtues or “competences” needed to flourish as a health care practitioner?
• To what extent are these intellectual skills and personal qualities innate and how much can they be taught?
• What aspects of ethical competence can be assessed and how should they be assessed?
• What knowledge, skills and virtues do GP teachers (trainers and programme directors) need to help their trainees learn what they need to learn about ethics and law?

Although the discussion will largely focus on GPs, another important issue is what common ground there is between GPs, other medical practitioners, other practitioners in health care (nurses, midwives, health visitors, managers, PAMs, in both primary and secondary care ) and with social work and social care;   and how those who offer the patient perspective can contribute to this process.

The presentation is intended to be a starting point for a discussion both during the session and afterwards, and the session will conclude with a consideration of options for taking this discussion forwards.

References

1Papanikitas A. and Toon P., (2011), Primary care ethics: a body of literature and a community of scholars?J R Soc Med, 104, 94 – 96

2 GMC (2014) Duties of a Doctor http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

3 Beachamp TL & Childress JF (2008) Principles of Biomedical Ethics 6^th Edition OUP Oxford

4 RCGP (2014) GP Curriculum Overview http://www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx

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